“I’m optimistic that one day children will no longer die of cholera”
UNICEF cholera vaccine procurement expert Hans Christiansen answers our questions about oral cholera vaccine (OCV) and the challenges of meeting the world’s need for doses in the face of multiple outbreaks.
What form does OCV take?
Oral cholera vaccine, as you can guess from the name, is given by mouth. It’s 1.5 ml of liquid (less than half a teaspoonful) that comes in a small plastic tube, that is simply squeezed out into a person’s mouth. It is easier to administer than an injectable product, it does not require ultra-cold storage and can be kept at 2–8 degrees centigrade.
There are three oral cholera vaccines that are approved by the World Health Organization, two of which are practical for UNICEF to use for prevention and outbreak response.
Is there a shortage of OCV?
Yes, we are currently seeing shortages of OCV. In 2016 UNICEF procured around 3 million doses a year, now we procure 30 million-plus, so supply has increased dramatically. However, demand has increased even more, both in terms of the number of requests and the quantities asked for.
Why has demand increased?
Unfortunately, there are multiple outbreaks such as in Syria, Haiti and Malawi. A more positive factor driving demand is that, as more OCV becomes available, more countries are deciding to use vaccination alongside other measures for cholera control, such as improvements in water, sanitation and community engagement.
What measures are in place to make the most of the available OCV supply and help communities affected by outbreaks?
Responding to outbreaks must have priority, of course. A body called the International Coordinating Group (ICG) manages an emergency stockpile that is used for these outbreaks. It was created in 2013 and contains 5 million doses that are available at all times, funded by Gavi, the Vaccine Alliance. Countries apply to the ICG and the group decides on potential allocations.
In October 2022, the experts in the ICG took a decision to reduce cholera vaccination campaigns to one dose – a course would normally be two doses. This was a necessary but tough decision to make, as the immunity from one dose does not last as long as when two doses are given. It’s a temporary measure.
What about preventative vaccination campaigns?
The Global Task Force on Cholera Control (GTFCC) makes allocation decisions about preventative campaigns and its secretariat is based within the World Health Organization. The hope is always to balance outbreak response and preventative campaigns and this will get easier as more supply becomes available or if demand from outbreaks decreases. UNICEF representatives sit on both the ICG and the GTFCC.
Can’t we just get more doses of vaccine?
UNICEF has secured all the suitable OCV that is available at the moment. There are currently two suppliers, one of which will be ceasing production in 2024, but the other, the larger of the two, is scaling up production. Together with our partners, we are working hard to bring more suppliers on board, and we are confident that in 3–4 years there will be a greatly increased supply.
What is your hope for the future?
Cholera can have a devastating impact on communities and children are especially vulnerable, but I am optimistic that, if we use every available tool, one day children will no longer die of cholera.
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Hans Christiansen is a Contracts Manager in UNICEF Supply Division’s Vaccine Centre. He has been working on procuring oral cholera vaccine since 2015.
